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General Surgery Coding Alert

CMS Unveils New ICD-9 Codes:

More Precision for Converted Surgeries, Muscle Weakness

Published on Fri Aug 01, 2003

New ICD-9 codes for 2004 will allow you to report several conditions or circumstances, including muscle weakness and converted surgeries, and in one case will simplify coding by eliminating a fifth digit from an already-existing diagnosis.
 
There really are no revolutionary changes to ICD-9 this year, but there are a number of interesting new codes, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb.
 
New signs and symptoms codes will be helpful in describing some of those situations that are hard to code when you dont have a definitive diagnosis, Bucknam says. These include:
  780.94 Early satiety
  781.94 Facial weakness
  785.52 Septic shock
  788.63 Urgency of urination
  790.21 Impaired fasting glucose
  790.22 Impaired glucose tolerance test (oral)
  790.29 Other abnormal glucose
  799.81 Decreased libido
  799.89 Other ill-defined conditions.
 
Other additions include new V codes for long-term drug use. These are going to be of interest to the vascular surgeons and possibly the surgical oncologists who have their patients on steroid or antiplatelet therapy that has to be monitored. Other surgeons will be interested in these codes because this long-term drug use adds to the complexity of surgical procedures and adds to healing times, post-op bleeding, etc., Bucknam says. The codes include:
 
  V58.63 Long-term (current) use of antiplatelet/antithrombotic
  V58.64 Long-term (current) use of nonsteroidalanti-inflammatories
  V58.65 Long-term (current) use of steroids.
 
Additionally, V64.4 now includes a fifth digit to better identify the various types of scope conversion procedures, as follows:
 
  V64.41 Laparoscopic surgical procedure converted to open procedure
  V64.42 Thoracoscopic surgical procedure converted to open procedure
  V64.43 Arthroscopic surgical procedure converted to open procedure.

Now You Can Report Muscle Weakness
 
A new code will finally allow physicians to specify a diagnosis of muscle weakness. Now, if a patient presents to your practice complaining of muscle weakness, your only choice is to report the code for unspecified disorder, 728.9 (Unspecified disorder of muscle, ligament, and fascia). For 2004, however, you may assign the new code 728.87 (Muscle weakness), which more accurately describes the patients condition.

 Most physicians are unsure of what unspecified codes such as 728.9 include, says Mary J. Brown, CPC, CMA, specialist at OrthoWest PC, a seven-physician practice in Omaha, Neb. More descriptive ICD-9 codes like 728.87 help paint a picture for your insurer, and that can save time by staving off unnecessary denials and appeals.
 
Note: CMS has not deleted 728.9. You may still assign this code for other muscle, ligament and fascia conditions that the more specific ICD-9 codes do not describe.

Go Ahead, Abbreviate the Difficulty-Walking Code
 
 If you report 719.7x (Difficulty in walking) today without adding a fifth digit to describe the site, your carrier will most likely deny the claim for a truncated diagnosis code. ICD-9 2003 dictates that this code is invalid without a fifth digit. But in 2004, that will no longer be the case.
 
Effective Oct. 1, CMS will delete codes 719.70 and 719.75-719.79, and replace them with the four-digit code 719.7, still described as difficulty in walking. The new code is a bit less specific because it no longer includes the site specifications, but it will be useful for those patients who only suffer from difficulty walking (such as due to neurological problems) and not because of specific joint conditions, Brown says.
 
If your patient has specific joint pain, however, you should bypass 719.7 and continue to report the 719.4x series, which specifies pain in joint, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
Other relevant changes for general surgery include:
  728.88 Rhabdomyolysis
  752.81 Scrotal transposition
  752.89 Other specified anomalies of genital organs
  766.21 Post-term infant
  767.11 Epicranial subaponeurotic hemorrhage (massive)
  767.19 Other injuries to scalp
  779.83 Delayed separation of umbilical cord
  780.93 Memory loss.
 
Note: CMS published a list of approximately 100 new and revised ICD-9 (diagnosis) codes in the May 19 Federal Register (Table 6A, page 27353). The codes have already undergone a public comment period and will be included in the next edition of the ICD-9 manual, to go into effect Jan. 1, 2004. To view a complete list of the new ICD-9 codes, go to http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-11966.htm.

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